Ischemic colitis other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
Among patients with a suspicion of ischemic colitis, endoscopic evaluation, via colonoscopy or flexible sigmoidoscopy, is the diagnostic procedure of choice if the diagnosis remains unclear after other imaging studies.
Endoscopy
- Ischemic colitis has a distinctive endoscopic appearance; endoscopy can also facilitate alternate diagnoses such as infection or inflammatory bowel disease. Biopsies can be taken via endoscopy to provide more information.[1][2]
- Early endoscopy can confirm the diagnosis and provides prognostic information.
- Distinguishes between cases that need conservative management versus those that require emergency resection.
- Transient non-gangrenous features of ischemic colitis observed at colonoscopy include:
- Petechial haemorrhages
- Edematous and fragile mucosa
- Segmental erythema
- Scattered erosions
- Longitudinal ulcerations (colon single stripe sign)
- A sharply defined segment of involvement
- Transmural ischemia will show:
- Cyanosis and pseudo-polyps
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Colonoscopy
- Colonoscopy findings for ischemic colitis are as follows:[2][3]
- Colonoscopy is more sensitive and allows visualization of colonic mucosa and histological analysis of biopsies.
- Diagnosis requires colonoscopy within 48 hours.
- Serial studies in connection with the clinical setting are necessary to establish the diagnosis.
- Performed with limited insufflation to avoid over distension of the colon.
- Could lead to further ischemia or perforation.
- CO2 insufflation rather than air should be used
- CO2 is rapidly absorbed and acts as a vasodilator.
References
- ↑ MacDonald, P.H. (2002). "Ischaemic colitis". Best Practice & Research Clinical Gastroenterology. 16 (1): 51–61. doi:10.1053/bega.2001.0265. ISSN 1521-6918.
- ↑ 2.0 2.1 Theodoropoulou, Αngeliki; Κoutroubakis, Ioannis E (2008). "Ischemic colitis: Clinical practice in diagnosis and treatment". World Journal of Gastroenterology. 14 (48): 7302. doi:10.3748/wjg.14.7302. ISSN 1007-9327.
- ↑ Washington, Christopher; Carmichael, Joseph (2012). "Management of Ischemic Colitis". Clinics in Colon and Rectal Surgery. 25 (04): 228–235. doi:10.1055/s-0032-1329534. ISSN 1531-0043.